Side event: A public health approach as a base for drug policy: The Portuguese case

Organised by the Government of Portugal.

H.E. AMB. Mendonca E Moura, P.R. Portugal to the UN, (moderator): Good morning and welcome everybody. There are brochures at the door.

Prof Fernando Araúo, Portuguese Secretary of State Assistant and of Health. Thank you all for joining this panel. The Portuguese policy on drugs over the last 50 years has been based on humanism and pragmatism, and there has been implementation of a more health and evidence-based approach. We have decriminalised personal possession of drugs. Drug conventions are flexible enough to support appropriate responses. The contribution of this panel to UNGASS 2016 is to debate the benefits of policies to reduce harm. Basing policies on health approaches is a success of UNGASS 2016.

Mr Alexis Goosdeel, Director of EMCDDA. ‘Towards a public health approach to drug use in the EU’

5 points I would like to share:

  1. European experience hasn’t started from a revelation. Started with heroin epidemic – the key word I would like to mention here is ‘health problem’. Public health is one of the two pillars of the European model. It explains how the nature of the problem has shaped the approach.
  2. Second key word – diversity. There are differences in cultures in Europe, and different drug trends.
  3. Pragmatism. Harm reduction programs save lives. We would prefer they stop consuming heroin, but we would prefer they just stay alive. This was a very important starting point. The issue for me is – what are the next revelations that we need to be prepared for?
  4. Flexibility – in each country, according to it’s priorities. Changes take 4 main forms – reducing prison sentences, removing prison sentences, depenalisation, and decriminalisation.
  5. Social experimentation – requires political courage. Need all evidence available to make such a courageous decision. Need to be prepared for future challenges. How can we build on past lessons for next generation of policy makers?

Scientific evidence is part of evidence-based policy making. It invovles choices and values. Scientific evidence is established in the Portuguese policy, and in evaluating the cost-effectiveness of the programs. Portugal is trying to better design its evaluation methods.

What we do not see in Europe is legalisation. There was confusion between decriminalisation and legalisation.

Mr João Goulão, National Coordinator for Drug Problems. ‘A public health approach as a base for drugs policy: the Portuguese case’

We are facing technical difficulties (with presentation). We work closely with the EMCCDA, and I want to thank them for the collaboration. Alexis spoke of flexibility – even if the sum of the UNGASS feels slow, I believe that the 15 year turnaround is actually quite quick. When we decided to decriminalise in Portugal, we came up to a lot against our decision, but now are happy to be seen as a successful drug policy. Decriminalisation is only one part of our policy, implemented in 2001. I am talking about addiction, dependance, diseases and health conditions – it doesn’t make sense to criminalise these activities – people need help. We were hoping to make social experimentation – 15 years later, we can show results. Our problems aren’t solved, but the improvements are impressive. Our responsibilities are to follow the results of these experiments. In Portugal we don’t feel pressure to change policy as we are happy with the figures that result from our programs. All countries believe their policies are the most effective – but it’s up to them to show this effectiveness. This is our 5 pillar model – (treatment, prevention, dissuasion, harm reduction, reintegration). Using drugs in Portugal is still prohibited, but punished under administrative law. We have established bodies to evaluate the situation of the drug user, and they are set under the Ministry of Health. If they are addicted, they are invited to join a treatment facility; if he is just a recreational user, we aim to evaluate the life situation of the user, and give the best response in terms of social and psychological health. Treatment is of course of capital importance – we have a solid set of treatment alternatives. Even if a citizen is not able to stop using drugs, he still deserves to have a better and longer life. This is the philosophy of harm reduction as we see it. We believe in the importance of reintegration. Possession of substances cannot exceed the quantity previewed for use for a 10 day period – exceeding this quantity, criminal procedures take place. This provides the opportunity of an early specific and integrated interface with drug users. The results – 15 years later – there has been a:

  • Small increase in reporting of illicit drug use in adults,
  • Reduced illicit drug use in adolescents since 2003
  • Reduced burden of drug offenders in the criminal justice system,
  • Reduction in prevalence of injecting drug use,
  • Reduction in opiate-related deaths and infectious diseases,
  • Reduced stigmatisation – this is very important,
  • Increased in amounts of seized drugs,

Study conducted concluded that the overall purpose of the Portuguese commission is to stop the use of illicit substances. 55% of participants said that the commission has contributed to changing their life, 45% said it hadn’t. 25% of this population said it made them reflect on their drug use.

Drug use in general population, and in the young adult population in Portugal – spiked in 2007, dropped by 2011. There has been an increase of treatment demand, and an increase in cannabis users in treatment. There has been a sharp decline in HIV infection in drug addicts since 2001, when policy of implemented. Drug related deaths are now at a very low number.

The decriminalisation model was redefined with priority and strategic options to promote the early intervention approach. Conclusions – scientific consensus concludes that criminal sanctions are ineffective and counter productive, they do nothing to protect the people.

Mr Werner Sipp, President of the INCB. ‘The Portuguese approach and the International Drug Control Conventions’

Thank you all for the great detail provided. The Portuguese approach has attracted much attention in international drug policy debate. However, the debate is characterised by misinterpretations – its innovative, but not unique, trends can be found in many other countries. What is unique is the specific institution outside the criminal justice system – The Commission for the Dissuasion of Drug Abuse. Other countries don’t offer an non-punitive alternative. The Portuguese approach is neither a ‘form of legalisation’ or ‘window into legalisation’.

INCB stated their views – visited in 2004 – the board examined the legal framework and noted that acquisition, possession and abuse has remained prohibited, there is just the practice of exempting small quantities. Further the implementation of law is an important element of the demand reduction mechanism INCB appreciates that the primary prevention of drug abuse is strengthened with the Portuguese drug policy.

Legal perspectives: limiting possession exclusive to medical and scientific purposes. This does not fit the conventions. In response to unlawful behaviours having a punishable offence – serious offences shalll be liable to adequate punishment. We can infer that minor offences must not be liable to punishment. This gives flexibility to states regarding degree of punishment.

How is this legal framework seen in Portugal – as possession is still deemed an offence, the law remains under the convention. The law states that drugs will be confiscated and dealt with by a multidisciplinary panel – penal sanctions are possible but not the primary objectives. The whole procedure can be seen as an alternative measure, which is in full compliance with the drug control conventions.

In conclusion, the Portugese procedure for dissuasion of drug abuse is in full compliance with the three drug control conventions. Experience may be useful to other countries where alternatives are under consideration. States have different approaches – what works in one national context cannot be transposed to another. This model of best practices is fully committed to the principles of conventions – putting health and welfare in the centre of drug policy applies a balanced approach.

 

Mr Aldo Lale-Demoz, Deputy Executive Director of the UNODC. ‘Alternatives to imprisonment from a health perspective’

Thank you for this very important side event. Policies must be based in public health and evidence based approaches. Overdose is a public health issue. The right to health applies to all people with drug use disorders. With the public health perspective, the recommended approach is not punitive. Drug users are members of our communities who are in need of support and treatment. We should consider alternatives to incarceration to sit in with a public health approach. More harms should not be created by drug policies – especially in relation to children and youth. They should have especially have access to health care and welfare alternatives. Alternatives must be designed along with the criminal justices system. For people who use drugs, fear of punishment is a major barrier to accessing treatment. We need needle and syringe programs, opioid substitute therapy and antiretroviral access. Member states have committed to end AIDS by 2030. At the most recent CND, the UNODC and WHO presented guidance on what evidence-based practice means, and how to provide it. The Tokyo rules and UN rules for women prisoners – the Bangkok rules – take into account gender perspective in custodial measures. Even in cases where people who use drugs have committed a crime, and where imprisonment is needed, access to treatment services should be provided – the Nelson Mandela rules are very important. Upon release, people who inject drugs are at high risk of overdose.

The Portuguese model is a fantastic achievement in drug policy approaches. The state is committed to drug control, but the consequences focus on pragmatic and humane issues. Authorities dealing with people who use drugs are well qualified. Law enforcement is targeted at more serious crimes. The Portuguese model shows how HIV rates have been reduced, and is an excellent public health approach. The state continually evaluates their processes. UNODC firmly believe that member states can benefit from hearing of these best practices. Let’s all work together for effective human and gender specific drug policies.

Moderator: We have time for 2 short questions.

Child/adolescent psychiatrist. Thank you for this courageous step.The war on drugs is war on people. With your dramatic step forward, I hope that the UN sees that this is the future, towards promotion in health and reducing psychological deprivation.

Moderator: I prepped UNGASS in 1998 – we have made great progress since then. This UNGASS document is a world away from the one in 1998.

Finnish Ministry of Health representative. Thank you – there are two important things that apply to every model. The first is that there is no magic bullet, it’s a comprehensive package where you have to have harm reduction and other things, and not just one path. The other thing is the multidisciplinary approach. The Portuguese model shows that enforcement is not the enemy and we can work together.

Moderator: Thank you. I need to conclude the meeting. We are very thankful that you all came to the meeting. Health not punishment – we have a multidisciplinary approach, but the emphasis is on health. This is based on scientific evidence and our permanent evaluation mechanism.

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